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Born out of necessity, telehealth has shot to prominence during the pandemic. But, putting the genie back in the bottle is another matter entirely.
A new study published in the Aesthetic Surgery Journal has uncovered the surprising new opportunity for telehealth in shaping the future of medicine.
Expanded telehealth services at the University of Texas Southwestern have proved effective in delivering safe patient care during the pandemic, leading to an increase in patients even in specialities such as plastic surgery.
“Prior to COVID-19, it was not clear if telehealth would meet the standard of care in highly specialised clinical practices. Out of necessity, we were forced to innovate quickly. What we found is that it is actually a really good fit,” says Alan Kramer, M.P.H., assistant vice president of health system emerging strategies at UTSW and co-author of the study.
UT Southwestern was already equipped with telehealth technology when the pandemic of COVID-19 took off, but only as a small pilot program. Through effort, however, telehealth was expanded across the institution within days, bringing with it a number of unexpected benefits for both the medical centre and its patients.
“The conversion rate to telehealth is higher than in person,” says Bardia Amirlak, M.D., FACS, associate professor of plastic surgery and the study’s senior corresponding author. The study found that 25,197 of 34,706 telehealth appointments at UT Southwestern were completed in April 2020—a 72.6% completion rate—compared to the 65.8% completion rate of April 2019.
Beginning in March 2020, there was a significant increase in the volume of new patients seen by telehealth. The study notes that the increase resulted from a combination of relaxed regulations and an increasing comfort level with telehealth visits among physicians and patients. UT Southwestern themselves saw the number of new patients seen through telehealth rise from 0.77% in February to 14.2% in March and then 16.7 in April.
The implementation of telehealth surprisingly thrived even in niche fields like plastic surgery, demonstrating the tractability of telehealth to a wide range of practices. From April to mid-May, plastic surgery completed 340 telehealth visits regarding breast cancer reconstruction, hand surgery, and wound care, with completion rates not dissimilar to those across the whole of UTSW. Plastic surgery also saw a large number of new patients who made up 41% of telehealth visits.
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“The fear was that the platform wouldn’t be able to handle it: the privacy issues, insurance issues, malpractice issues … but it came together well and we were able to ramp up into the thousands and were able to not only decrease patient anxiety, but also increase many beneficial factors, such as patient access,” says Amirlak.
The study reports several benefits telehealth seems to have over more traditional forms of medicine, such as a reduction in stress, more hospital visits, no travel time, no exposure to pathogens and a reduction in missed work, in addition to improving access to care with the option for out-of-state consultations. In fact, UTSW has seen patients from 43 states and Puerto Rico take advantage of UTSW facilities via telehealth since March.
Even as COVID-19 restrictions are being dialled back in the state of Texas, telehealth is still a major element of UT Southwestern’s clinical practice.
“The feedback from patients has been very positive,” says Kramer. “We’re now sustaining 25% of our practice being done virtually, a major win for our patients. It’s changed the way we think about care.”
It hasn’t been without its challenges though. The practicality and risks of remote diagnostic medicine is an obvious one, and there are arguments that in many cases the value of the in-person physical exam just cannot be replaced.
Furthermore, in response to the COVID-19 pandemic, many statutes and restrictions were loosened to allow institutions such as UTSW to implement telehealth swiftly and effectively—it remains to be seen how developments of long-term regulations affect the future of telehealth.
The implementation of telehealth surprisingly thrived even in niche fields like plastic surgery, demonstrating the tractability of telehealth to a wide range of practices.
“It will be our responsibility as physicians and scientists to recognise the potential dangers of taking telehealth to the extreme right now and missing a clinical diagnosis,” Amirlak says.
“Based on the trends, it seems that telehealth is here to stay. So it’s important to think about the concerns, and based on this information, the issues that we have and how we can resolve them going forward,” says Christine Wamsley, a UTSW research fellow and first author of the study.
Whether this trend continues into the post-COVID-19 world remains to be seen.